Labiaplasty

Written by Dr Jill Tomlinson on 11 December 2011.

Female genital cosmetic surgery is a term that encompasses a number of different procedures that have been talked about and performed more frequently in recent years. Labiaplasty (sometimes termed labioplasty) is the most commonly performed procedure, but female genital cosmetic surgery or vaginal rejuvenation has also been considered to include procedures such as liposculpture of the mons and labia majora, clitoral hood reduction, hymenoplasty, partial clitoridectomy and perineoplasty.

Why do women choose to undergo labiaplasty?

Women seek labiaplasty for functional and/or cosmetic concerns. Women with functional concerns report problems with discomfort when wearing tight clothing (jeans or gym wear) or when undertaking specific activities. Women with cosmetic concerns report that they are dissatisfied with the appearance of their labia or perineum, and that this has adverse psychological effects.

It is very important to realise that the appearance of the labia varies widely - there is no single "normal" appearance of the female genitalia, just as there is no single "normal" appearance of male genitalia. It is not abnormal for the labia minora (the "inner lips") to protrude past the labia majora (the "outer lips"). In fact, this is very common. If you're wondering if your labia are normal the Labia Library from Women's Health Victoria is a great resource.

There is no evidence to suggest that labiaplasty surgery can reduce problems with recurrent thrush or address hygiene concerns or problems.

How do I know if I should have labiaplasty surgery?

You have plenty of opportunity to think about any decision you make regarding labiaplasty surgery - it's definitely not surgery to rush into. Often women who are wondering about the surgery are not sure if their genitals are normal, or may be unsure as to what the range of "normal" is. Many of the images of female genitals that we see have been airbrushed due to Australian classification guideline requirements, so while it is entirely your decision whether to seek to undertake the surgery it is a good idea to be clear in your own mind about exactly why you are seeking the surgery and what your goals are. Some of the questions you should consider are:

what functional problems, if any, do you have (eg difficulty wearing tight clothing, interference with activities)?

do your labia fit within the wide range of normal?

how do you feel about the way your labia look (length, colour, thickness etc)?

what sort of surgical result would you consider ideal (appearance or function)?

how do you think the surgery would alter the way you feel about yourself, or your ability to undertake specific activities?

What does labiaplasty surgery involve?

Labiaplasty is day-case surgery that can be done under general anaesthetic, local anaesthetic with sedation or local anaesthetic. There are a few different surgical approaches to reducing the size or changing the shape of the labia. Your surgeon will discuss the differences in these with you, including the pros and cons of each approach. The most common approaches are either removal of a V-shaped wedge from one or more areas along the labia minora, or trimming of the labia minora, or a combination of these two. If you are concerned about the shape of your mons pubis or your labia majora it is possible to have fat transferred - either to reduce or increase volume in these areas.

What is the recovery time?

It is sensible to plan to take a week away from work and your usual activities. It is common to have significant swelling and discomfort after the operation, although this can be managed with ice packs, rest and analgesia. You will be able to shower and wash after the surgery. Dissolving sutures are used, so you will not need to have sutures removed. The site of surgery will be sensitive for up to 6 weeks and during this time you should avoid activities like bike riding and vaginal intercourse.

Can I see some before and after results?

What are the success rates of female genital cosmetic surgery?

There is a lack of evidence about the success rates and the complications of female genital cosmetic surgery. Dr Jill Tomlinson has been involved in educational campaigns and forums, including with Women's Health Victoria and with Family Planning NSW, to raise awareness of the wide range of normal variation in female genitalia and to promote the use of surgery in a safe, ethical and evidence-based manner. Dr Tomlinson was instrumental in the development of a Position Statement on Female Genital Cosmetic Surgery which was adopted by the Australian Federation of Medical Women and the Executive Council of the Medical Women's International Association in 2012. Dr Tomlinson upholds the right of women to choose to undergo lawful surgical procedures and strives to ensure that patients who undergo this surgery are comfortable with their decision and fully educated about the non-surgical and surgical options available.

Potential complications

Labiaplasty surgery is not a major surgical procedure, however complications of labiaplasty surgery may include:

Bleeding- It is possible, though unusual; it may require emergency treatment.

Infection - Infection is unusual after this type of surgery. Antibiotics or additional surgery may be necessary.

Change in skin sensation- Diminished (or loss of) skin sensation in the labia may not totally resolve after labiaplasty.

Skin contour irregularities- This may cause alteration in the appearance of the edge of the labia. Visible and palpable wrinkling of skin can occur.

Pigment irregularities- Visible discoloration of the leading edge of the labia majora/minora can occur.

Scarring - Scars may be unattractive and of different color than surrounding skin. Additional treatments including surgery may be necessary to treat abnormal scarring.

Surgical anaesthesia - There is the possibility of complications, injury, and even death from all forms of surgical anaesthesia or sedation; these complications are very rare.

Asymmetry- Labia are normally uneven. Symmetry may not result from labiaplasty. Many other anatomical features may contribute to normal asymmetry in body features.

Delayed healing- Wound disruption or delayed wound healing is possible. This may require frequent dressing changes or further surgery to remove the non-healed tissue.

Allergic reactions

Swelling- Malposition, scarring, unacceptable appearance or loss of the labia may occur.

Long term effects- Subsequent alterations in body contour may occur as the result of aging, weight loss or gain, pregnancy, or other circumstances not related to labiaplasty.

Pain- Chronic pain may occur very infrequently from nerves becoming trapped in scar tissue after labiaplasty. Pain due to other associated conditions may not be relieved by labiaplasty.

Other- You may be disappointed with the results of surgery. Infrequently, it is necessary to perform additional surgery to improve your results.

Discussing these potential complications with your surgeon will allow you to better understand the recovery period, detect any problems early and understand the risks and benefits of surgery.

What should I do before my appointment?

If you are seeking labiaplasty you need to obtain a referral from a doctor before your appointment.

What will happen at my appointment?

At your appointment Dr Tomlinson will ask you questions about your general health and the reasons you are seeking a labiaplasty. Dr Tomlinson will examine you and have a detailed discussion with you regarding your preferences, the best surgical technique for you (wedge or trim method), what the surgery and recovery involves and the risks of surgery. You will have the opportunity to look at a variety of images of labia so that you and Dr Tomlinson can plan your surgery. If you agree, photographs may be taken of your labia so that these can be discussed with you and you can be informed about what outcome you can expect from the surgery.

Dr Tomlinson will confirm the surgical plan with you, you will be provided with in-depth information, you will be offered the opportunity to ask any additional questions and you will be able to select the timing for your surgery. You will be asked to sign a consent form for the surgery and given information about the cost of surgery. If you have not been referred by your general practitioner we will ask that before we perform the surgery you provide us with a letter from an independent doctor that states that you have a health or medical reason for seeking labiaplasty.

There is no rush to proceed with labiaplasty surgery and if you require additional appointments to discuss your treatment prior to proceeding with surgery we are very happy to do this.

Why do I need to obtain a referral or a letter from another doctor saying that I have a health reason for seeking labiaplasty?

"Vulvoplasty or labioplasty, in a patient aged 18 years or more, performed by a specialist in the practice of the specialist's specialty, for a structural abnormality that is causing significant functional impairment, if the patient's labium extends more than 8 cm below the vaginal introitus while the patient is in a standing resting position."

The item code 35534 is only valid for inpatient surgical procedures. A Medicare rebate will not be paid for outpatient procedures.

If your labium does not extend more than 8cm below the vaginal introitus while in the standing resting position you are not eligible for Medicare or private health insurance rebates on labiaplasty surgery. Labiaplasties that are performed as a rooms procedure under local anaesthetic are not eligible for Medicare or private health insurance rebates.

How much does labiaplasty surgery cost?

If you have private health insurance and are eligible for a Medicare rebatable procedure (labium >8cm) the cost will be approximately $2850, depending on your level of coverage (including whether you have an excess on your private health insurance). To determine if your private health insurance covers you for a Medicare-approved labiaplasty contact your fund and ask if you are covered for surgery with the Medicare item number 35534. Your health fund will be able to advise you what reimbursements they provide for this treatment and what the out of pocket cost will be for your hospital admission.

If you do not have private health insurance it costs approximately $5600 to have this procedure performed in a private surgical facility as day case surgery under the care of a fully qualified anaesthestist and specialist plastic surgeon Dr Jill Tomlinson.

Labiaplasty can be performed as an in-rooms procedure under local anaesthetic; the procedure costs approximately $3700. The fees quoted are inclusive of follow up appointments with Dr Tomlinson.

To schedule an appointment to see Dr Tomlinson about labiaplasty please phone (03) 9427-9596.